November, 2022

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AI transforms smartwatch ECG signals into diagnostic tool for heart failure

Medical Xpress - ECG

A study published in Nature Medicine reports the ability of a smartwatch ECG to accurately detect heart failure in nonclinical environments. Researchers at Mayo Clinic applied artificial intelligence (AI) to Apple Watch ECG recordings to identify patients with a weak heart pump.

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2 Signs You Could Be Diabetic

MIBHS

Signs You Could Be Diabetic Diabetes is one of the most common chronic illnesses in the US today. It can lead to heart disease, chronic pain and numbness in the extremities, loss of eyesight, and even amputation of toes and feet if not kept under careful control. Early symptoms are often overlooked. Knowing the signs may help you catch diabetes early and prevent long-term cardiovascular damage.

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Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Dr. Smith's ECG Blog

This case was provided by Spencer Schwartz, an outstanding paramedic at Hennepin EMS who is on Hennepin EMS's specialized "P3" team, a team that receives extra training in advanced procedures such as RSI, thoracostomy, vasopressors, and prehospital ultrasound. This patient, who is a mid 60s female with a history of hypertension, hyperlipidemia and GERD, called 911 because of chest pain.

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The experts who loved lockdowns until it was cool to hate them.

Dr. Anish Koka

Three years after the virus first emerged in Wuhan, China is the only major country in the world still attempting to stop transmission of COVID-19 - a “zero COVID” approach that requires forced constant testing, confinement to your apartment if anyone on an adjacent floor tests positive, and mandatory removal to quarantine centers. After three long years of not knowing if you can leave your apartment complex tomorrow, the Chinese population appears to be cracking.

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Remote monitoring in patients with heart failure with cardiac implantable electronic devices: a systematic review and meta-analysis

Open Heart

Background Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) is now the standard of care, but whether the demonstrated benefits of RM translate into improvements in heart failure (HF) management is controversial. This systematic review addresses the role of RM in patients with HF with a CIED. Methods and results A systematic search of the literature for randomised clinical trials in patients with HF and a CIED assessing efficacy/effectiveness of RM was performed using MEDL

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EM Quick Hits 44 Fluids in Pancreatitis, Nasal Fractures, Delirium, DOSE VF, Intimate Partner Violence

ECG Cases

In this EM Quick Hits podcast: Justin Morgenstern on fluids in pancreatitis, Leeor Sommer on nasal fractures, Christina Shenvi on delirium, Sheldon Cheskes and Rohit Mohindra on Dose VF, and Noor Khatib and Kari Sampsel on intimate partner violence. The post EM Quick Hits 44 Fluids in Pancreatitis, Nasal Fractures, Delirium, DOSE VF, Intimate Partner Violence appeared first on Emergency Medicine Cases.

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Mark Groeneweg Celebrates 20 Years at Cassling

Cassling

At Cassling, we seek to deliver a high-quality customer service experience that exceeds the expectations of our customers. It’s ingrained in who we are and what we do. But Regional Service Manager Mark Groeneweg takes this commitment so he seriously that he once tracked down a FedEx truck to get a part for a customer.

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Patient in Single Vehicle Crash: What is this ST Elevation, with Peak Troponin of 6500 ng/L?

Dr. Smith's ECG Blog

A 30-something male was involved in a single vehicle crash and had multiple injuries. As a routine part of his critical trauma evaluation, he had an ECG recorded: There is an rSR" in V1 and V2, with downsloping ST segment and inverted T-wave which is very similar to a Brugada Type 1 phenocopy. I was shown this ECG and thought that it could perhaps be Brugada, but I was more suspicious for Right Ventricular (RV) myocardial contusion.

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The real heart disease gender gap and the cardiologists that get it all wrong.

Dr. Anish Koka

Image by Pexels from Pixabay There would appear to be confusion among some cardiologists about the relative prevalence of malignant heart disease between men and women as evidenced by this exchange on twitter from pre-pandemic times. The only trouble with the 2018 stats from the American Heart Association that are dutifully amplified by a professor of cardiology at a major academic hospital is that it is completely misleading.

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Haemostasis and fibrinolysis after regular high-intensity interval training in patients with coronary artery disease: a randomised controlled trial

Open Heart

Introduction Patients with coronary artery disease (CAD) have prothrombotic changes compared with healthy individuals. Regular exercise reduces cardiovascular mortality in patients with stable CAD. However, the underlying mechanism for the beneficial effect is unknown. We investigated whether regular exercise would inhibit platelet aggregation and thrombin generation and increase fibrinolysis in patients with CAD.

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2023 STS Coding Workshop

Society of Thoracic Surgeons - Allied Health

Event 2023 STS Coding Workshop kchalko Tue, 11/15/2022 - 16:12 Event dates Feb 10–11, 2023 Location Virtual Registrants : To access the library of on-demand content, log into the STS Learning Center. Then go to “In Progress” courses on the dashboard or look in the “My Activities” tab. You may view the course archive and claim credit until February 1, 2024.

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New FDA-Approved Aortic Technologies

Society of Thoracic Surgeons - Technology

Webinar New FDA-Approved Aortic Technologies kchalko Thu, 11/10/2022 - 12:30 November 3, 2022 Recent approvals by the U.S. Food and Drug Administration (FDA) have made available two new technologies for treating aortic disease. The GORE® TAG® Thoracic Branch Endoprosthesis (TBE) is single-branch aortic stent graft that provides an off-the-shelf solution for patients that need zone II aortic coverage and obviates the need for prior left subclavian revascularization.

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How Much Does an MRI Scanner Cost?

Cassling

Purchasing a new MRI scanner can be a lengthy, daunting process. Making the right decision means considering multiple options, features, and capabilities, then choosing the one system that is just right for your needs. You’ll likely consider a number of MRI vendors, each of whom claim to have the best technology, service and support. No pressure at all, right?

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A man in his 70s with chest pain

Dr. Smith's ECG Blog

Case submitted by Rachel Plate MD, written by Pendell Meyers A man in his 70s presented with chest pain which had started acutely at rest and has lasted for 2 hours. The pain was still ongoing at arrival. He also noted a bilateral "odd feeling" in his arms. He stated it was similar to prior heart attacks. He had history of prior MIs and CABG, as well as diabetes, hypertension, and hyperlipidemia.

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ECG Cases 37 ECG interpretation in electrolyte emergencies

ECG Cases

While most of us have a clear algorithm in our minds for the management of life-threatening hyperkalemia, the same may not be said about the other life-threatening electrolyte abnormalities. In this ECG Cases blog Dr. Jesse MacLaren gives us an approach to potassium, calcium and magnesium abnormalities including risk factor assessment, ECG interpretation and management pearls.

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Uric acid in advanced heart failure: relation to central haemodynamics and outcome

Open Heart

Objective The role of hyperuricaemia as a prognostic maker has been established in chronic heart failure (HF) but limited information on the association between plasma uric acid (UA) levels and central haemodynamic measurements is available. Methods A retrospective study on patients with advanced HF referred for right heart catherisation. Regression analyses were constructed to investigate the association between UA and haemodynamic variables.

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We Love Our Heart

Dr. Malcolm Kendrick

6th November 2022 Ivor Cummins and me, and our part in Big Pharma’s downfall… Ivor Cummins and Mark Felsted are running another conference looking at the causes of cardiovascular disease. I shall be speaking and presenting a few more thoughts. For example, why has the rate of CVD shot up in the last eighteen months? Possibly explanations? I hope you can attend, and you will all hopefully learn something new, and help us in our endless quest to derail the big pharma leviathan – or perhaps scratch

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Assessing and improving healthcare workflow.

iRythm Technologies

Healthcare workflow optimization overview that covers clinical workflow and provides an ambulatory cardiac monitor workflow example.

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5 Helpful Strategies to Cope with and Welcome Change

Cassling

Change is one of the only constants in our lives, and we can count on it daily. While we might see change as a stressor, can you imagine your life without change? No improved health, no increase in pay, no new home, and no upcoming vacation!

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What do you think of this "Ventricular Bigeminy"?

Dr. Smith's ECG Blog

Written by Bobby Nicholson MD, with edits by Meyers A woman in her 50s with past medical history of heart failure, prior stroke, atrial fibrillation on Eliquis, lung cancer in remission, and CKD, presented to the emergency department for evaluation of cough and shortness of breath. EKG was obtained in triage and read as ventricular bigeminy. What do you think?

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Ep 176 Orthopedic X-rays Master Class – Pitfalls in Obtaining and Interpreting MSK X-rays

ECG Cases

Do not let a negative X-ray rule the day! Like almost all medical tests X-rays are far from perfect and should be ordered and interpreted only in the context of a thorough history and physical exam. In this 2nd part of our 2-part series on orthopedic x-rays with Dr. Arun Sayal and Dr. Yatin Chadha we discuss the pitfalls of obtaining and interpreting orthopedic X-rays, when orthopedic X-ray decision tools lead us astray, how understanding the concept of central ray helps dictate how we should or

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Pharmacological treatment in patients with aortic dissection

Open Heart

Objectives To describe medical management in aortic dissection (AD) and to analyse the possible associations between antihypertensive, antithrombotic, anticoagulant and statin agents, respectively, and long-term survival. Methods From Swedish medical registers, all patients diagnosed with AD in 2006–2015 were identified. Filled prescriptions prior to admission and within 1 year from discharge in patients discharged and alive at 30 days were registered.

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Cleaning the Augean stables (Part I)

Dr. Malcolm Kendrick

24th November 2022 Peer-review: Time to get rid of it ‘There seems to be no study too fragmented, no hypothesis too trivial, no literature citation too biased or too egotistical, no design too warped, no methodology too bungled, no presentation of results too inaccurate, too obscure, and too contradictory, no analysis too self-serving, no argument too circular, no conclusions too trifling or too unjustified, and no grammar and syntax too offensive for a paper to end up in print.’ Dru

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How to Keep Your Heart Healthy During the Holidays

AMS Cardiology

Almost 700,000 people in the United States die from heart disease annually, making up one in every five deaths. It’s no surprise that heart disease is the leading cause of death for men and women in the US and nationwide. As we try to combat these startling numbers with daily exercise, a better diet and keeping our stress levels low, we find we indulge the most throughout the winter months.

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America, the intolerant

Dr. Anish Koka

Historically, the great tension between liberty and authority was between government as embodied by the ruling class and its subjects. Marauding barbarians and warring city-states meant that society endowed a particular class within society with great powers to protect the weaker members of society. It was quickly recognized that the ruling class could use these powers for its own benefit on the very people it was meant to protect, and so society moved to preserve individual liberties first by r

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Sometimes even ST Elevation meeting criteria is not enough to be convincing

Dr. Smith's ECG Blog

Written by Emre Aslanger. Emre is a new Editor of the Blog. He is an interventionalist in Turkey. A 50 something-year-old man with a history of newly diagnosed hypertension and diabetes, for which he did not take any medication, presented a non-PCI-capable center with a vague, but central chest pain. His vitals were normal and his first ECG was as shown below: There is obvious ST segment elevation (STE) in anterior leads.

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Global EM 1: Practicing EM in Bangladesh – Build It and They Will Come

ECG Cases

Dr. Navpreet Sahsi describes the challenges of building an Emergency Department in Bangladesh and how the experience has shaped his outlook on Emergency Medicine practice in North America on EM Cases' first Global EM blog. The post Global EM 1: Practicing EM in Bangladesh – Build It and They Will Come appeared first on Emergency Medicine Cases.

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Does recovery from submaximal exercise predict response to cardiac resynchronisation therapy?

Open Heart

Background Exercise parameters are not routinely incorporated in decision making for cardiac resynchronisation therapy (CRT). Submaximal exercise parameters better reflect daily functional capacity of heart failure patients than parameters measured at maximal exertion, and may therefore better predict response to CRT. We compared various exercise parameters, and sought to establish which best predict CRT response.

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An elderly woman with acute vomiting, presyncope, and hypotension, and a wide QRS complex

Dr. Smith's ECG Blog

Written by Pendell Meyers Family of an elderly woman with many comorbidities called EMS when she suddenly experienced shortness of breath, nausea, vomiting, and near syncope. She was alert and oriented and hypotensive with initial BP 70/50. A 12 lead ECG was obtained by EMS and is shown below: What do you think? There is sinus tachycardia (do not be fooled into thinking this is VT or another wide complex tachycardia!

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I was shown this ECG without any information. What do you think?

Dr. Smith's ECG Blog

I was shown this ECG; "Steve, what do you think of this?": What is going on? I said: "This is pulse tapping artifact and a long QT" Why did I say that? Whenever you see a very bizarre EKG, you should think about pulse tapping artifact. This is when one of the limb lead electrodes is placed over an artery, especially when placed over a dialysis fistula.

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Changes in platelet function and coagulation after transcatheter aortic valve implantation evaluated with thromboelastography

Open Heart

Introduction The possibility of hypercoagulability during the perioperative period of transcatheter aortic valve implantation (TAVI) has been noted; however, there is still a controversy regarding the appropriate perioperative antithrombotic therapy. The study investigated coagulation and platelet functions during the TAVI perioperative period using thromboelastography (TEG) 6s platelet mapping.

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Design and rationale of the inferior vena CAVA and Lung UltraSound-guided therapy in Acute Heart Failure (CAVAL US-AHF Study): a randomised controlled trial

Open Heart

Background Between 25% and 30% of patients hospitalised for acute heart failure (AHF) are readmitted within 90 days after discharge, mostly due to persistent congestion on discharge. However, as the optimal evaluation of decongestion is not clearly defined, it is necessary to implement new tools to identify subclinical congestion to guide treatment.

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90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Dr. Smith's ECG Blog

Case submitted and written by Mazen El-Baba MD, with edits from Jesse McLaren and edits/comments by Smith and Grauer A 90-year old with a past medical history of atrial fibrillation, type-2 diabetes, hypertension, dyslipidemia, presented with acute onset chest/epigastric pain, nausea, and vomiting. BP was 110 and oxygen saturation was normal. What is your ECG interpretation and what would you do next?

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Development of algorithms for determining heart failure with reduced and preserved ejection fraction using nationwide electronic healthcare records in the UK

Open Heart

Background Determining heart failure (HF) phenotypes in routine electronic health records (EHR) is challenging. We aimed to develop and validate EHR algorithms for identification of specific HF phenotypes, using Read codes in combination with selected patient characteristics. Methods We used The Healthcare Improvement Network (THIN). The study population included a random sample of individuals with HF diagnostic codes (HF with reduced ejection fraction (HFrEF), HF with preserved ejection fractio

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Developing a contemporary community clinic for patients with heart failure with preserved ejection fraction within the current National Health Service model

Open Heart

Introduction The diagnostic and therapeutic arsenal for heart failure with preserved ejection (HFpEF) has expanded. With novel therapies (eg, sodium-glucose co-transporter 2 inhibitors) and firmer recommendations to optimise non-cardiac comorbidities, it is unclear if outpatient HFpEF models can adequately deliver this. We; therefore, evaluated the efficacy of an existing dedicated HFpEF clinic to find innovative ways to design a more comprehensive model tailored to the modern era of HFpEF.

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Opiate overdose, without chest pain or shortness of breath. Cognitive dissonance.

Dr. Smith's ECG Blog

I was reading EKGs on the system and saw this one. What did I put in as my interpretation? Interpretation : "Acute LAD occlusion until proven otherwise. " There is non-diagnostic ST Elevation in V1-V3, with rather large T-waves but in the context of a deep S-wave (high voltage). HOWEVER, lead V4 is diagnostic of OMI. This is massive ST Elevation, huge hyperacute T-wave, and loss of S-wave (which in V4, unlike V2-3, can be normal but should greatly raise suspicion.

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Differences of cardiovascular risk assessment in clinical practice using SCORE and SCORE2

Open Heart

Objective Cardiovascular risk estimation is an essential step to reduce the onset of adverse cardiovascular events. For this purpose, the Systematic Coronary Risk Evaluation (SCORE) risk chart method was used in Europe. In 2021, the SCORE2 algorithm was released, bringing changes in the calculation methodology. This study assessed and compared the level of cardiovascular risk in a population aged 40–65 years using the SCORE and SCORE2 methodologies.

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